Last year, I contemplated my risk of staying on birth control pills until I reach menopause and lamented the dearth of research on the long-term use of contraceptives by women. Well, I feel a little vindicated after reading a review paper published yesterday in the Journal of the American College of Cardiology. The authors, female cardiologists from Cedars-Sinai Medical Center in Los Angeles, complain that there aren't well-designed trials looking specifically at how birth control pills and other hormonal products affect a woman's risk of developing heart disease.
While a woman's risk of having a heart attack in her 30s or 40s is extremely low, heart disease death rates have recently risen in women ages 35 to 44, and no one knows exactly why. This could be due to an increase in obesity, sedentary lifestyle, and smoking, all of which raise heart disease risk. But it could also be because more middle-aged women are using hormonal contraceptives today than ever before. The paper, study coauthor Noel Bairey Merz tells me, is a resounding call for more research.
"If these were male contraceptives, we'd know so much more already," she contends. Those are fighting words; but as director of the Women's Heart Center at Cedars-Sinai, Merz has long studied the gender disparities that exist when it comes to screening and treating women for heart disease.
Containing a combination of the female hormones estrogen and progestin (a synthetic version of progesterone), birth control pills appear to protect against uterine and ovarian cancer and strengthen bones. They may or may not raise breast cancer risk, and their effects on women's hearts and arteries still aren't completely known. The review study found that oral contraceptives may slightly affect cholesterol levels, shifting the "good" HDL cholesterol downward; they may also raise blood pressure, worsen glucose tolerance (a factor in diabetes), and increase the risk of rare blood clots.
But you may not need to worry. "For healthy, lean, nonsmoking women, oral contraceptives can safely be continued into their early 50s," says Andrew Kaunitz, associate chairman of the department of obstetrics and gynecology at the University of Florida College of MedicineJacksonville, "allowing them to maintain effective contraception and even avoid perimenopausal symptoms like hot flashes and irregular bleeding." (Though these symptoms often hit once women go off estrogen cold turkey.)
You might want to reconsider, though, if you're over 35 and already at increased risk of heart disease because of one or more of the following factors:
If you're not a good candidate for the pill, safe alternatives include progestin-only contraception like the Depo Provera injection, the Implanon implant, or the Mirena IUD. Nonhormonal methods like the copper IUD or tubal ligation are also available. Of course, we're all still waiting for that contraceptive pill for men. Perhaps in my daughter's or granddaughter's lifetime....
Corrected on : Corrected on 01/15/09: An earlier version of this story misstated the name of the Mirena IUD.